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Gall bladder
Adenomyomatosis

Gall bladder adenomyomatosis ultrasound case study

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Reporting Panel

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Gall bladder Pathology

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USG

Gall bladder adenomyomatosis ultrasound case study

CASE–1

Clinical History

A 48-year-old patient presented with intermittent right upper quadrant abdominal pain and dyspepsia. There was no history of fever, jaundice, or weight loss. Ultrasound was performed for evaluation of hepatobiliary symptoms.

Ultrasound Findings

Ultrasound examination demonstrates a focal area of gallbladder wall thickening involving the fundal region, Multiple tiny intramural cystic spaces (Rokitansky–Aschoff sinuses) are noted within the thickened wall, producing characteristic comet-tail (ring-down) reverberation artifacts. The remaining gallbladder wall is normal in thickness. No intraluminal calculus, pericholecystic fluid, or sonographic Murphy's sign is identified. The common bile duct is normal in caliber.

Report Line

A focal area of gallbladder wall thickening is seen involving the fundal region, measuring approximately ____ mm in thickness. Multiple tiny intramural cystic spaces with associated comet-tail reverberation artifacts are identified, consistent with Rokitansky–Aschoff sinuses. No gallstones, pericholecystic fluid, or biliary ductal dilatation is noted. Sonographic features are suggestive of focal adenomyomatosis of the gallbladder.

Impression

Features are consistent with focal adenomyomatosis of the gallbladder .

Recommendation

Clinical correlation is recommended. In asymptomatic patients, no specific treatment is usually required. Surgical consultation may be considered if symptoms persist or if imaging findings are atypical. Follow-up ultrasound or MRI may be performed when differentiation from gallbladder neoplasm is clinically indicated.

Key Learning Points

• Gallbladder adenomyomatosis is a benign hyperplastic condition characterized by proliferation of the mucosa and muscular layer.
• Focal adenomyomatosis most commonly involves the gallbladder fundus.
• Rokitansky–Aschoff sinuses appear as tiny intramural cystic spaces on ultrasound.
• Comet-tail (ring-down) reverberation artifact is a characteristic sonographic feature.
• The condition is usually asymptomatic and is often detected incidentally.
• Absence of an irregular mass, liver invasion, significant vascularity, or regional lymphadenopathy favors a benign diagnosis.
• MRI may be useful when ultrasound findings are atypical or malignancy cannot be confidently excluded.